Unnecessary Circumcision

by

George C. Denniston, M.D., M.P.H.

In recent years, the debate on circumcision has been conducted on a relatively low plane, with proponents arguing that circumcision may prevent some rare conditions. Opponents of circumcision argue that it simply has no medical benefits, and is a violation of a man's right to grow up with an intact body. Perhaps the subject can be simplified and raised to a higher plane by focusing on the positive value of the foreskin.

Before birth, the glans penis is covered with skin. This skin is not loosely attached. Indeed it is as tightly attached to the glans as is the skin on the hand.

At approximately 17 weeks of intra­uterine life, cells in the area of separation between the future foreskin and the glans initiate the process of creating the preputial space (the space between the glans penis and the intact foreskin). This process is completed by the age of 3 years in 90% of boys, but it may take as long as 17 years for some boys to have a fully retractable foreskin.

At birth, the separation of the foreskin from the glans has just begun. The newborn's penis is, of course, not yet fully developed. Not only does circumcision interfere with its development, but it requires that the surgeon tear the skin from the sensitive glans to permit removal. As a result, scarring occurs, the surface of the glans thickens, and the urinary opening often gets smaller.

If physicians would simply leave the newborn's penis alone, as Dr. Benjamin Spock recommends in the latest edition of Baby and Child Care, the foreskin would be left to fulfill its several functions. In infancy, the foreskin protects the glans from irritation and from fecal material. In adulthood, the function of the foreskin may at first seem obscure. The shaft and the glans of an intact (uncircumcised) man's penis are covered by skin. Retracting the foreskin reveals the glans and makes the skin on the shaft somewhat loose. Of what use is this redundant skin? During erection, the penile shaft elongates, becoming about 50% longer. The foreskin covers this lengthened shaft. It is designed to accommodate an organ that is capable of a marked increase in diameter, as well as length.

In addition, the foreskin is the most sensitive part of the penis and can enhance the quality of sexual intercourse. Anatomical studies demonstrate that the foreskin has a greater concentration of complex nerve endings than the glans. If there were any possibility that the foreskin could contribute significantly to sexual enjoyment, is that not a cogent reason for rethinking our motives for this ritual procedure?

History shows that the arguments in favor of circumcison are questionable. At the beginning of this century, one of the reasons given for circumcision was to decrease masturbation, which was thought to lead to insanity and other "morbid" conditions. We now know that circumcision does not prevent masturbation, nor does masturbation lead to insanity.

More recently, circumcision was promoted as a means of preventing cervical cancer in the man's sexual partners; this notion has been proved incorrect.

The current excuses are that failure to remove the foreskin may contribute to urinary tract infections and penile cancer, but neither of these contentions has been proved. Even if either were correct, the risk of urinary tract infection in an uncircumcised infant is only one in one hundred. Performing 100 mutilative surgeries to possibly prevent one treatable urinary tract infection is not valid preventive medicine - it is just another excuse.

Penile cancer occurs in older men at the rate of approximately 1 in 100,000. The idea of performing 100,000 mutilating (by definition) procedures on newborns to possibly prevent cancer in one elderly man is absurd. Applying this type of reasoning to women would lead to the conclusion that removing all breasts at puberty should be done to prevent breast cancer.

One thousand years ago, the Jewish sage Maimonides said that the effect of circumcision was "to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate... for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when... deprived of its covering from the beginning."

Who has the right to order or perform such surgery on a newborn infant? I contend that no one does - certainly not the physician who should know better - since there is no proven medical reason to do so, and the procedure is known by many to be harmful. Circumcision can always be performed in adulthood for men who desire it, with fully informed consent.

Physicians who continue to perform routine circumcision are not only harming infants but are also harming the integrity of the medical profession. It is hard to accept that these physicians - many of whom have been circumcised themselves - are using their medical licenses to continue this contra­indicated practice. This is tragedy perpetuating itself.